title: Attentional avoidance of negative experiences as predictor of postoperative pain ratings and consumption of analgesics: comparison with other psychological predictors.
abstract: OBJECTIVE
  Attentional avoidance of negative stimuli and preference for positive stimuli (assessed prior to surgery) have been found to be predictive of postoperative pain. However, findings so far were mainly obtained in young patients with benign diagnoses. The aim of the present study was to test whether this relationship holds for aged patients with poorer prognosis.
  
  
  METHODS
  Preoperatively assessed psychological predictors, including attentional measures for emotionally loaded stimuli, among others, were used to predict acute postoperative pain as indicated by rating and consumption of analgesics.
  
  
  METHODS
  Fifty-eight patients scheduled for surgery due to cancer (80%) with a mean age of 60.5 years participated in the study.
  
  
  METHODS
  As predictors attentional biases for pain-related, social threat, and positive stimuli were assessed in a dot-probe task. Further predictors were self-reported pain vigilance, pain anxiety, pain catastrophizing, general anxiety, depression, and somatization, as well as pressure pain thresholds. As criteria of prediction, numerical scale ratings of acute postoperative pain and the amount of analgesics (patient-controlled intravenous analgesia [PCIA]) requested after surgery were used.
  
  
  RESULTS
  Only the dot-probe task parameters provided significant explanation of acute postoperative pain. A significant 23% of variance of the PCIA use was accounted for by the dot-probe task parameters. Here, it was mainly the avoidance of social threat words which contributed to significant prediction and did not appear to be related to the other psychological predictors. Seventy-seven percent of the patients with frequent PCIA use could be classified correctly by this variable.
  
  
  CONCLUSIONS
  Attentional avoidance of emotionally negative stimuli prior to surgery proved to be a powerful predictor of acute postoperative pain reflected by the consumption of analgesics; this time in a sample of aged patients with various but mainly malign diagnoses. This measure outperformed traditional predictors like depression, anxiety, as well as pain catastrophizing, and deserves further attention.
authors.affiliation: Otto-Friedrich University Bamberg, Germany. stefan.lautenbacher@uni-bamberg.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Lautenbacher
authors.forename: Claudia
authors.initials: C
authors.lastname: Huber
authors.forename: Corinna
authors.initials: C
authors.lastname: Baum
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Sieglinde
authors.initials: S
authors.lastname: Hochrein
authors.forename: Michael
authors.initials: M
authors.lastname: Heesen
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D001288:Attention / Q000502:physiology*; D001362:Avoidance Learning / Q000502:physiology; D058443:Catastrophization; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement; D017288:Pain Threshold / Q000523:psychology; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology*; D011237:Predictive Value of Tests; D012919:Social Behavior
chemical_list: D000700:Analgesics